Help. Sex Hurts.

Hi Is This Normal,

I thought having sex after delivering my baby would be awkward. Maybe a little gross. Maybe a little uncomfortable for me, something new to figure out. Never did I think sex would cause me such pain. Excruciating – do-not-touch-me – horrible, horrible pain. I feel tight, raw, swollen and damaged. It’s been plenty of time since I had my child, and nothing has changed.

What do I do? How can I fix this?

Sex Hurts

Dear Sex Hurts,

This is one of those things we just don’t talk about enough, isn’t it? We talk a lot about sex to make the baby (never in my life have I known more about another woman’s basal temp and sex schedule then when my friends were TTC). We talk about sex during pregnancy. We talk about all the gory glory that the joys of postpartum bring, including that second “first time”. But once that 6-8 week mark comes and goes, the sex thing sort of fades away. We don’t check in on our postpartum friends to ask about how the sexy time is going. We don’t trade stories about how we’re managing to get busy with leaking boobs. Clearly, there are things to talk about here!

OK, so first things first: I’m going to assume you’re more than 6-8 weeks out from delivery, and were given the all-clear by your doc to get have sex. You mentioned some expectations you had for that first sex sesh after baby, and in my experience, those all sound pretty normal? But we’re not talking about it being awkward or slightly uncomfortable. You’re talking about pain. Real, excruciating pain, and THAT isn’t normal. Sex shouldn’t be excruciatingly painful, regardless of whether or not you’re recovering from childbirth. When sex hurts that bad, it’s usually an indication that something is wrong. According to Dr. Jen Gunter, board certified gynecologist and pain medicine physician, there are a few common causes of painful sex after you’ve had a baby.

First, let’s talk about our friend estrogen. Breastfeeding can cause estrogen levels in the vagina to drop, leading to dryness and pain. Think of estrogen like WD40 for your vagina – it keeps things nice and lubricated! When you breastfeed, your estrogen levels can be depleted, making sex very painful. For a lot of women who experience this, all the lube in the world may not be enough. A small amount of vaginal estrogen cream can help increase the levels until your periods have returned to normal. But check in with your gyno and ask her about this.

Second, if you had an episiotomy or tore during your delivery and required stitches, there could be an issue with how your scar is healing. TMI alert: my stitches after my second didn’t heal quite … right, and I had moderate pain and discomfort for two years after she was born until I finally asked my doctor to fix it! You didn’t mention when the sex is most painful, but if you’re having a particularly hard time with penetration, you may want your doc to take a look at your nethers to see how they’re healing. My own doctor likened stitching someone up after childbirth to trying to stitch together wet paper towels, which is absolutely horrifying to imagine but makes SO MUCH SENSE.

Finally, the muscles in your pelvic floor could be spasming. Those super important muscles can become too tight after childbirth, and can lead to very painful sex. Dr. Gunter says the feeling is often described by women and their partners as “hitting a painful wall” during penetration. But the good news is pelvic floor physical therapy is highly effective at getting those muscles to relax!

The bottom line is, painful sex (at any time!) isn’t normal, and you shouldn’t have to just deal with it. There’s likely a very real reason you’re experiencing so much pain during sex, and your doctor should be able to help you figure out what the problem is and get you back on the horse, so to speak. If your doctor doesn’t seem particularly concerned, then I would suggest getting a second opinion. Painful sex may not be life-threatening, but it can definitely affect your quality of life, and that’s just as important.